Quantitative Susceptibility Mapping: Contrast Mechanisms and Clinical Applications

Evaluation of abnormal iron distribution in specific regions in the brains of patients with Parkinson's disease using quantitative susceptibility mapping and R2* mapping

The primary aim of the present study was to evaluate abnormal iron distribution in specific regions of the brains in patients with Parkinson's disease (PD) using quantitative susceptibility mapping (QSM) and R2^* mapping, and to compare the diagnostic performances of QSM and R2^* mapping in differentiating patients with PD with that in normal controls. A total of 25 patients with idiopathic PD and 28 sex-and age-matched normal controls were included in the present study and their brains investigated using a 3T scanner. Magnetic resonance imaging techniques, namely, QSM and R2^* mapping, were applied to generate susceptibility and R2^* values. The differences in susceptibility and R2^* values in deep grey matter nuclei between patients with PD and the normal controls were compared using independent samples t-tests. The abilities of QSM and R2^* mapping to classify patients with PD and normal controls were analyzed using receiver operating characteristic curves. Correlation analyses between imaging parameters (e.g. susceptibility and R2^* values) and clinical feature (disease severity assessed using the Hoehn and Yahr score) were performed. The intra-class correlation coefficient (ICC) for susceptibility (ICC=0.977; P<0.001) and R2^* (ICC=0.945; P<0.001) values between two neuro-radiologists were >0.81, showing excellent inter-rater agreement. The susceptibility values were significantly increased in the substantia nigra (SN) and red nucleus, but were decreased in the putamen of patients with PD compared with that in the corresponding brain regions of normal controls. However, increased R2^* values were observed only in the SN in patients with PD. QSM showed higher sensitivity and specificity compared with R2^* mapping to separate the patients with PD from the normal controls. There were no significant correlations between the susceptibility/R2^* values and clinical features in all targeted regions of the brains in patients with PD. In conclusion, both QSM and R2^* mapping are feasible to calculate the iron levels in human brains, and QSM provides a more sensitive and accurate method to assess regional abnormal iron distribution in patients with PD.

Investigation of quantitative susceptibility mapping in diagnosis of tuberous sclerosis complex and assessment of associated brain injuries at 1.5 Tesla

BACKGROUND AND AIM

Tuberous sclerosis complex (TSC) is a rare disease with serious clinical consequences such as mental deficiency and epilepsy. The pathological changes of TSC include demyelination and subependymal calcified nodules. Quantitative susceptibility mapping (QSM) is a newly developed imaging technique which is capable of quantitatively measuring the susceptibility induced by iron deposition, calcification, and demyelination. The aim of this study was to investigate the use of QSM in detecting the subependymal nodules and assessing brain tissue injuries induced by cortical/subcortical tubers in TSC patients.

MATERIALS AND METHODS

Twelve clinically confirmed TSC patients and fifteen gender- and age-matched healthy subjects underwent measurement with conventional magnetic resonance imaging (MRI) sequences, diffusion tensor imaging (DTI), and QSM. The TSC patients further underwent a computed tomography (CT) scan. Considering CT as the ground truth, the detection rates of subependymal nodules using conventional MRI and QSM were compared by the paired Chi-square test, and the sensitivity and specificity were computed. The Bland-Altman test and independent t-test were performed to compare the susceptibility of cortical/subcortical regions from QSM and fractional anisotropy (FA) values from DTI between the patient and control groups, Pearson correlation was performed to examine the correlation between the susceptibility and FA values.

RESULTS

QSM was better in detecting subependymal calcified nodules compared to conventional MR sequences (X ²=40.18, P<0.001), QSM achieved a significantly higher sensitivity of 98.3% and a lower specificity of 50%, which was compared with conventional MR sequences (46.7% and 75%, respectively). The susceptibility value of cortical/subcortical tubers in TSC patients was significantly higher than those in the control group (t=9.855, P<0.001), while FA value was lower (t=-8.687, P<0.001). Pearson correlation test revealed a negative correlation between susceptibility and FA values in all participants (r=-0.65, P<0.001).

CONCLUSIONS

QSM had a similar ability in TSC compared to CT and DTI. QSM may provide valuable complementary information to conventional MRI imaging and may simplicity imaging of patients with TSC.

RELEVANCE FOR PATIENTS

This study shows the feasibility of QSM to detect subependymal calcified nodules. It may provide quantitative information of white matter damage of tuberous sclerosis patients.

QSMGAN: Improved Quantitative Susceptibility Mapping using 3D Generative Adversarial Networks with increased receptive field

Quantitative susceptibility mapping (QSM) is a powerful MRI technique that has shown great potential in quantifying tissue susceptibility in numerous neurological disorders. However, the intrinsic ill-posed dipole inversion problem greatly affects the accuracy of the susceptibility map. We propose QSMGAN: a 3D deep convolutional neural network approach based on a 3D U-Net architecture with increased receptive field of the input phase compared to the output and further refined the network using the WGAN with gradient penalty training strategy. Our method generates accurate QSM maps from single orientation phase maps efficiently and performs significantly better than traditional non-learning-based dipole inversion algorithms. The generalization capability was verified by applying the algorithm to an unseen pathology--brain tumor patients with radiation-induced cerebral microbleeds.

Imaging the Centromedian Thalamic Nucleus Using Quantitative Susceptibility Mapping

The centromedian (CM) nucleus is an intralaminar thalamic nucleus that is considered as a potentially effective target of deep brain stimulation (DBS) and ablative surgeries for the treatment of multiple neurological and psychiatric disorders. However, the structure of CM is invisible on the standard T1- and T2-weighted (T1w and T2w) magnetic resonance images, which hamper it as a direct DBS target for clinical applications. The purpose of the current study is to demonstrate the use of quantitative susceptibility mapping (QSM) technique to image the CM within the thalamic region. Twelve patients with Parkinson's disease, dystonia, or schizophrenia were included in this study. A 3D multi-echo gradient recalled echo (GRE) sequence was acquired together with T1w and T2w images on a 3-T MR scanner. The QSM image was reconstructed from the GRE phase data. Direct visual inspection of the CM was made on T1w, T2w, and QSM images. Furthermore, the contrast-to-noise ratios (CNRs) of the CM to the adjacent posterior part of thalamus on T1w, T2w, and QSM images were compared using the one-way analysis of variance (ANOVA) test. QSM dramatically improved the visualization of the CM nucleus. Clear delineation of CM compared to the surroundings was observed on QSM but not on T1w and T2w images. Statistical analysis showed that the CNR on QSM was significantly higher than those on T1w and T2w images. Taken together, our results indicate that QSM is a promising technique for improving the visualization of CM as a direct targeting for DBS surgery.

Automated adaptive preconditioner for quantitative susceptibility mapping

PURPOSE

To develop an automated adaptive preconditioner for QSM reconstruction with improved susceptibility quantification accuracy and increased image quality.

THEORY AND METHODS

The total field was used to rapidly produce an approximate susceptibility map, which was then averaged and trended over R 2 ∗ binning to generate a spatially varying distribution of preconditioning values. This automated adaptive preconditioner was used to reconstruct QSM via total field inversion and was compared with its empirical counterparts in a numerical simulation, a brain experiment with 5 healthy subjects and 5 patients with intracerebral hemorrhage, and a cardiac experiment with 3 healthy subjects.

RESULTS

Among evaluated preconditioners, the automated adaptive preconditioner achieved the fastest convergence in reducing the RMSE of the QSM in the simulation, suppressed hemorrhage-associated artifacts while preserving surrounding brain tissue contrasts, and provided cardiac chamber oxygenation values consistent with those reported in the literature.

CONCLUSION

An automated adaptive preconditioner allows high-quality QSM from the total field in imaging various anatomies with dynamic susceptibility ranges.

Quantitative Susceptibility Mapping: MRI at 7T versus 3T

BACKGROUND AND PURPOSE

Ultrahigh-field 7T promises more than doubling the signal-to-noise ratio (SNR) of 3T for magnetic resonance imaging (MRI), particularly for MRI of magnetic susceptibility effects induced by B₀ . Quantitative susceptibility mapping (QSM) is based on deconvolving the induced phase (or field) and would therefore benefit substantially from 7T. The purpose of this work was to compare QSM performance at 7T versus 3T in an intrascanner test-retest experiment with varying echo numbers (5 and 10 echoes).

METHODS

A prospective study in N = 10 healthy subjects was carried out at both 3T and 7T field strengths. Gradient echo data using 5 and 10 echoes were acquired twice in each subject. Test-retest reproducibility was assessed using Bland-Altman and regression analysis of region of interest measurements. Image quality was scored by an experienced neuroradiologist.

RESULTS

Intrascanner bias was below 3.6 parts-per-billion (ppb) with correlation R² > .85. Interscanner bias was below 10.9 ppb with correlation R² > .8. The image quality score for the 3T 10 echo protocol was not different from the 7T 5 echo protocol (P = .65).

CONCLUSION

Excellent image quality and good reproducibility was observed. 7T allows equivalent image quality of 3T in half of the scan time.

Observation of magnetic susceptibility changes within the thalamus: a comparative study between healthy and Parkinson’s disease afflicted cynomolgus monkeys using 7 T MRI

Background

Although the thalamus is known to modulate basal ganglia function related to motor control activity, the abnormal changes within the thalamus during distinct medical complications have been scarcely investigated. In order to explore the feasibility of assessing iron accumulation in the thalamus as an informative biomarker for Parkinson’s disease (PD), this study was designed to employ quantitative susceptibility mapping using a 7 T magnetic resonance imaging system in cynomolgus monkeys. A 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-injected cynomolgus monkey and a healthy control (HC) were examined by 7 T magnetic resonance imaging. Positron emission tomography with 18F-N-(3-fluoro propyl)-2ß-carboxymethoxy-3ß-(4-iodophenyl) nortropane was also employed to identify the relationship between iron deposits and dopamine depletion. All acquired values were averaged within the volume of interest of the nigrostriatal pathway.

Findings

Compared with the HC, the overall elevation of iron deposition within the thalamus in the Parkinson’s disease model (about 53.81% increase) was similar to that in the substantia nigra (54.81%) region. Substantial susceptibility changes were observed in the intralaminar part of the thalamus (about 70.78% increase). Additionally, we observed that in the Parkinson’s disease model, binding potential values obtained from positron emission tomography were considerably decreased in the thalamus (97.51%) and substantia nigra (92.48%).

Conclusions

The increased iron deposition in the thalamus showed negative correlation with dopaminergic activity in PD, supporting the idea that iron accumulation affects glutaminergic inputs and dopaminergic neurons. This investigation indicates that the remarkable susceptibility changes in the thalamus could be an initial major diagnostic biomarker for Parkinson’s disease-related motor symptoms.

Learning-based single-step quantitative susceptibility mapping reconstruction without brain extraction

Quantitative susceptibility mapping (QSM) estimates the underlying tissue magnetic susceptibility from MRI gradient-echo phase signal and typically requires several processing steps. These steps involve phase unwrapping, brain volume extraction, background phase removal and solving an ill-posed inverse problem relating the tissue phase to the underlying susceptibility distribution. The resulting susceptibility map is known to suffer from inaccuracy near the edges of the brain tissues, in part due to imperfect brain extraction, edge erosion of the brain tissue and the lack of phase measurement outside the brain. This inaccuracy has thus hindered the application of QSM for measuring susceptibility of tissues near the brain edges, e.g., quantifying cortical layers and generating superficial venography. To address these challenges, we propose a learning-based QSM reconstruction method that directly estimates the magnetic susceptibility from total phase images without the need for brain extraction and background phase removal, referred to as autoQSM. The neural network has a modified U-net structure and is trained using QSM maps computed by a two-step QSM method. 209 healthy subjects with ages ranging from 11 to 82 years were employed for patch-wise network training. The network was validated on data dissimilar to the training data, e.g., in vivo mouse brain data and brains with lesions, which suggests that the network generalized and learned the underlying mathematical relationship between magnetic field perturbation and magnetic susceptibility. Quantitative and qualitative comparisons were performed between autoQSM and other two-step QSM methods. AutoQSM was able to recover magnetic susceptibility of anatomical structures near the edges of the brain including the veins covering the cortical surface, spinal cord and nerve tracts near the mouse brain boundaries. The advantages of high-quality maps, no need for brain volume extraction, and high reconstruction speed demonstrate autoQSM's potential for future applications.

Noninvasive quantification of oxygen saturation in the portal and hepatic veins in healthy mice and those with colorectal liver metastases using QSM MRI

PURPOSE

This preclinical study investigated the use of QSM MRI to noninvasively measure venous oxygen saturation (SvO2) in the hepatic and portal veins.

METHODS

QSM data were acquired from a cohort of healthy mice (n = 10) on a 9.4 Tesla MRI scanner under normoxic and hyperoxic conditions. Susceptibility was measured in the portal and hepatic veins and used to calculate SvO2 in each vessel under each condition. Blood was extracted from the inferior vena cava of 3 of the mice under each condition, and SvO2 was measured with a blood gas analyzer for comparison. QSM data were also acquired from a cohort of mice bearing liver tumors under normoxic conditions. Susceptibility was measured, and SvO2 calculated in the portal and hepatic veins and compared to the healthy mice. Statistical significance was assessed using a Wilcoxon matched-pairs signed rank test (normoxic vs. hyperoxic) or a Mann-Whitney test (healthy vs. tumor bearing).

RESULTS

SvO2 calculated from QSM measurements in healthy mice under hyperoxia showed significant increases of 15% in the portal vein (P < 0.05) and 21% in the hepatic vein (P < 0.01) versus normoxia. These values agreed with inferior vena cava measurements from the blood gas analyzer (26% increase). SvO2 in the hepatic vein was significantly lower in the colorectal liver metastases cohort (30% ± 11%) than the healthy mice (53% ± 17%) (P < 0.05); differences in the portal vein were not significant.

CONCLUSION

QSM is a feasible tool for noninvasively measuring SvO2 in the liver and can detect differences due to increased oxygen consumption in livers bearing colorectal metastases.

Imaging beta amyloid aggregation and iron accumulation in Alzheimer's disease using quantitative susceptibility mapping MRI

Beta amyloid is a protein fragment snipped from the amyloid precursor protein (APP). Aggregation of these peptides into amyloid plaques is one of the hallmarks of Alzheimer's disease. MR imaging of beta amyloid plaques has been attempted using various techniques, notably with T2* contrast. The non-invasive detectability of beta amyloid plaques in MR images has so far been largely attributed to focal iron deposition accompanying the plaques. It is believed that the T2* shortening effects of paramagnetic iron are the primary source of contrast between plaques and surrounding tissue. Amyloid plaque itself has been reported to induce no magnetic susceptibility effect. We hypothesized that aggregations of beta amyloid would increase electron density and induce notable changes in local susceptibility value, large enough to generate contrast relative to surrounding normal tissues that can be visualized by quantitative susceptibility mapping (QSM) MR imaging. To test this hypothesis, we first demonstrated in a phantom that beta amyloid is diamagnetic and can generate strong contrast on susceptibility maps. We then conducted experiments on a transgenic mouse model of Alzheimer's disease that is known to mimic the formation of human beta amyloid but without neurofibrillary tangles or neuronal death. Over a period of 18 months, we showed that QSM can be used to longitudinally monitor beta amyloid accumulation and accompanied iron deposition in vivo. Individual beta amyloid plaque can also be visualized ex vivo in high resolution susceptibility maps. Moreover, the measured negative susceptibility map and positive susceptibility map could provide histology-like image contrast for identifying deposition of beta amyloid plaques and iron. Finally, we demonstrated that the diamagnetic susceptibility of beta amyloid can also be observed in brain specimens of AD patients. The ability to assess beta amyloid aggregation non-invasively with QSM MR imaging may aid the diagnosis of Alzheimer's disease.

Weak-harmonic regularization for quantitative susceptibility mapping

PURPOSE

Background-field removal is a crucial preprocessing step for quantitative susceptibility mapping (QSM). Remnants from this step often contaminate the estimated local field, which in turn leads to erroneous tissue-susceptibility reconstructions. The present work aimed to mitigate this undesirable behavior with the development of a new approach that simultaneously decouples background contributions and local susceptibility sources on QSM inversion.

METHODS

Input phase data for QSM can be seen as a composite scalar field of local effects and residual background components. We developed a new weak-harmonic regularizer to constrain the latter and to separate the 2 components. The resulting optimization problem was solved with the alternating directions of multipliers method framework to achieve fast convergence. In addition, for convenience, a new alternating directions of multipliers method-based preconditioned nonlinear projection onto dipole fields solver was developed to enable initializations with wrapped-phase distributions. Weak-harmonic QSM, with and without nonlinear projection onto dipole fields preconditioning, was compared with the original (alternating directions of multipliers method-based) total variation QSM algorithm in phantom and in vivo experiments.

RESULTS

Weak-harmonic QSM returned improved reconstructions regardless of the method used for background-field removal, although the proposed nonlinear projection onto dipole fields method often obtained better results. Streaking and shadowing artifacts were substantially suppressed, and residual background components were effectively removed.

CONCLUSION

Weak-harmonic QSM with field preconditioning is a robust dipole inversion technique and has the potential to be extended as a single-step formulation for initialization with uncombined multi-echo data.

An MR technique for simultaneous quantitative imaging of water content, conductivity and susceptibility, with application to brain tumours using a 3T hybrid MR-PET scanner

Approaches for the quantitative mapping of water content, electrical conductivity and susceptibility have been developed independently. The purpose of this study is to develop a method for simultaneously acquiring quantitative water content, electrical conductivity and susceptibility maps based on a 2D multi-echo gradient echo sequence. Another purpose is to investigate the changes in these properties caused by brain tumours. This was done using a 3T hybrid magnetic resonance imaging and positron emission tomography (MR-PET) scanner. Water content maps were derived after performing T₂* and transmit-receive field bias corrections to magnitude images essentially reflecting only the H₂O content contrast. Phase evolution during the multi-echo train was used to generate field maps and derive quantitative susceptibility, while the conductivity maps were retrieved from the phase value at zero echo time. Performance of the method is demonstrated on phantoms and two healthy volunteers. In addition, the method was applied to three patients with brain tumours and a comparison to maps obtained from PET using O-(2-[18 F]fluoroethyl)-L-tyrosine and clinical MR images is presented. The combined information of the water content, conductivity and susceptibility may provide additional information about the tissue viability. Future studies can benefit from the evaluation of these contrasts with shortened acquisition times.

Patents on Quantitative Susceptibility Mapping (QSM) of Tissue Magnetism

BACKGROUND

Quantitative susceptibility mapping (QSM) depicts biodistributions of tissue magnetic susceptibility sources, including endogenous iron and calcifications, as well as exogenous paramagnetic contrast agents and probes. When comparing QSM with simple susceptibility weighted MRI, QSM eliminates blooming artifacts and shows reproducible tissue susceptibility maps independent of field strength and scanner manufacturer over a broad range of image acquisition parameters. For patient care, QSM promises to inform diagnosis, guide surgery, gauge medication, and monitor drug delivery. The Bayesian framework using MRI phase data and structural prior knowledge has made QSM sufficiently robust and accurate for routine clinical practice.

OBJECTIVE

To address the lack of a summary of US patents that is valuable for QSM product development and dissemination into the MRI community.

METHOD

We searched the USPTO Full-Text and Image Database for patents relevant to QSM technology innovation. We analyzed the claims of each patent to characterize the main invented method and we investigated data on clinical utility.

RESULTS

We identified 17 QSM patents; 13 were implemented clinically, covering various aspects of QSM technology, including the Bayesian framework, background field removal, numerical optimization solver, zero filling, and zero-TE phase.

CONCLUSION

Our patent search identified patents that enable QSM technology for imaging the brain and other tissues. QSM can be applied to study a wide range of diseases including neurological diseases, liver iron disorders, tissue ischemia, and osteoporosis. MRI manufacturers can develop QSM products for more seamless integration into existing MRI scanners to improve medical care.

Quantitative susceptibility mapping (QSM) with an extended physical model for MRI frequency contrast in the brain: a proof-of-concept of quantitative susceptibility and residual (QUASAR) mapping

Quantitative susceptibility mapping (QSM) aims to calculate the tissue's magnetic susceptibility distribution from its perturbing effect on the MRI static main magnetic field. The method is increasingly being applied to study iron and myelin in clinical and preclinical settings. However, recent experimental and theoretical findings have challenged the fundamental theoretical assumptions that form the basis of current numerical implementations of QSM algorithms. The present work introduces a new class of susceptibility mapping algorithms, termed quantitative susceptibility and residual mapping (QUASAR), which takes into account frequency contributions not related to the spatial variation of bulk magnetic susceptibility in the Lorentz sphere model. We present a simple proof-of-concept QUASAR algorithm that, unlike most of the QSM algorithms currently used widely, results in an improved anatomical accuracy of the susceptibility distribution without any a priori assumptions about the susceptibility distribution during the field-to-source inversion. The algorithm was evaluated both in silico and in vivo in the preclinical setting. Our preliminary application of QUASAR in rodents provides the first in vivo evidence that the susceptibility-field model traditionally used in the QSM field cannot fully explain the frequency contrast in brain tissues. Only when an additional local frequency contribution is added to the physical model can the frequency contrast in the brain be related properly to the underlying anatomy.

Pros and cons of ultra-high-field MRI/MRS for human application

Magnetic resonance imaging and spectroscopic techniques are widely used in humans both for clinical diagnostic applications and in basic research areas such as cognitive neuroimaging. In recent years, new human MR systems have become available operating at static magnetic fields of 7 T or higher (≥300 MHz proton frequency). Imaging human-sized objects at such high frequencies presents several challenges including non-uniform radiofrequency fields, enhanced susceptibility artifacts, and higher radiofrequency energy deposition in the tissue. On the other side of the scale are gains in signal-to-noise or contrast-to-noise ratio that allow finer structures to be visualized and smaller physiological effects to be detected. This review presents an overview of some of the latest methodological developments in human ultra-high field MRI/MRS as well as associated clinical and scientific applications. Emphasis is given to techniques that particularly benefit from the changing physical characteristics at high magnetic fields, including susceptibility-weighted imaging and phase-contrast techniques, imaging with X-nuclei, MR spectroscopy, CEST imaging, as well as functional MRI. In addition, more general methodological developments such as parallel transmission and motion correction will be discussed that are required to leverage the full potential of higher magnetic fields, and an overview of relevant physiological considerations of human high magnetic field exposure is provided.

Susceptibility mapping of the dural sinuses and other superficial veins in the brain

Quantitative susceptibility mapping (QSM) is a means to obtain direct measurements of local tissue susceptibility distribution. Usually the focus is on imaging tissues in the brain, and the region of the brain studied is dictated by an eroded skull stripped mask. Producing the pristine local phase behavior for regions at the edge of the brain has been difficult in the past. For structures such as the superior sagittal sinus (SSS) that run alongside the surface of the brain and under the skull bones, a considerable part of the external phase from the dipole effect is lost due to the short T2* of the bones. In this paper, we propose a method that seeks to reconstruct the susceptibility distribution inside the dural sinuses by ensuring that the entire geometry of the dural sinuses is preserved with the help of an MR angiogram and venogram (MRAV). Having a geometrical model of the vessels makes it possible to estimate the missing phase outside the brain as well, by using the forward phase model and, hence, allowing a complete phase map to be reconstructed. Fifteen healthy volunteers were scanned using a susceptibility weighted imaging (SWI) sequence with interleaved rephased-dephased echoes. QSM results were compared between the conventional techniques and the proposed method of phase preservation outside the brain and inside the dural sinuses. This method demonstrates the reconstruction of the SSS, whereas conventional methods are either unable to preserve this structure or unable to provide complete phase information. The mean and standard deviation inside the SSS for all volunteers was 435 ± 5 ppb (this is the inter-subject error). To validate the proposed approach, the mean susceptibility inside the straight sinus showed good agreement between conventional approach and the proposed method. The results presented in this study indicate the potential of generating the susceptibility map for the whole brain, including the SSS (as well as potentially all the cortical veins).

Region-specific susceptibility change in cognitively impaired patients with diabetes mellitus

Emerging evidence suggests that diabetes mellitus (DM) is associated with iron and calcium metabolism. However, few studies have investigated the presence of DM in cognitively impaired patients and its effect on brain iron and calcium accumulation. Therefore, we assessed the effects of DM on cognitively impaired patients using quantitative susceptibility mapping (QSM). From June 2012 to Feb 2014, 92 eligible cognitively impaired patients underwent 3T magnetic resonance imaging (MRI). There were 46 patients with DM (DM+) and 46 aged matched patients without DM (DM-). QSM was obtained from gradient echo data and analyzed by drawing regions of interest around relevant anatomical structures. Clinical factors and vascular pathology were also evaluated. Measurement differences between DM+ and DM- patients were assessed by t tests. A multiple regression analysis was performed to identify independent predictors of magnetic susceptibility. DM+ patients showed lower susceptibility values, indicative of lower brain iron content, than DM- patients, which was significant in the hippocampus (4.80 ± 8.31 ppb versus 0.22 ± 10.60 ppb, p = 0.024) and pulvinar of the thalamus (36.30 ± 19.88 ppb versus 45.90 ± 20.02 ppb, p = 0.023). On multiple regression analysis, microbleed number was a predictor of susceptibility change in the hippocampus (F = 4.291, beta = 0.236, p = 0.042) and DM was a predictor of susceptibility change in the pulvinar of the thalamus (F = 4.900, beta = - 0.251, p = 0.030). In cognitively impaired patients, presence of DM was associated with lower susceptibility change in the pulvinar of the thalamus and hippocampus. This suggests that there may be region-specific alterations of calcium deposition in cognitively impaired subjects with DM.

Quantitative susceptibility mapping (QSM) as a means to monitor cerebral hematoma treatment

BACKGROUND

Quantitative susceptibility mapping (QSM) offers a consistent hemorrhage volume measurement independent of imaging parameters.

PURPOSE

To investigate the magnetic susceptibility of intracerebral hemorrhage (ICH) as a quantitative measurement for monitoring treatment in hematoma patients.

STUDY TYPE

Prospective.

POPULATION

Twenty-six patients with acute ICH were recruited and enrolled in treatment including surgery or medication (mannitol) for 1 week.

FIELD STRENGTH/SEQUENCE

A 3D gradient echo sequence at 3.0T.

ASSESSMENT

The hematoma volumes on computed tomography (CT) and QSM were calculated and used for correlation analysis. Magnetic susceptibility changes from pre- to posttreatment were calculated and compared to the National Institutes of Health stroke scale (NIHSS) measure of neurological deficit for each patient.

STATISTICAL TESTS

Mean susceptibility values were calculated over each region of interest (ROI). A one-sample t-test was used to assess the changes of total volumes and mean magnetic susceptibility of ICH identified between pre- and posttreatment images (P < 0.05 was considered significant) and the Bland-Altman analysis with 95% limits of agreement (average difference, ±1.96 SD of the difference). Regression of volume measurements on QSM vs. CT and fitted linear regression of mean susceptibility vs. CT signal intensity for hematoma regions were conducted in all patients.

RESULTS

Good correlation was found between hemorrhage volumes calculated from CT and QSM (CT volume = 0.94*QSM volume, r = 0.98). Comparison of QSM pre- and posttreatment showed that the mean ICH volume was reduced by a statistically insignificant amount from 5.74 cm3 to 5.45 cm3 (P = 0.21), while mean magnetic susceptibility was reduced significantly from 0.48 ppm to 0.38 ppm (P = 0.004). A significant positive association was found between changes in magnetic susceptibility values and NIHSS following hematoma treatment (P < 0.01).

DATA CONCLUSIONS

QSM in hematoma assessment, as compared with CT, offers a comparably accurate volume measurement; however, susceptibility measurements may enable improved monitoring of ICH treatment compared to volume measurements alone.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:907-915.

Quantitative susceptibility mapping in the human fetus to measure blood oxygenation in the superior sagittal sinus

OBJECTIVES

To present the feasibility of performing quantitative susceptibility mapping (QSM) in the human fetus to evaluate the oxygenation (S_vO₂) of cerebral venous blood in vivo.

METHODS

Susceptibility weighted imaging (SWI) data were acquired from healthy pregnant subjects (n = 21, median = 31.3 weeks, interquartile range = 8.8 weeks). The susceptibility maps were generated from the SWI-phase images using a modified QSM processing pipeline, optimised for fetal applications. The processing pipeline is as follows: (1) mild high-pass filtering followed by quadratic fitting of the phase images to eliminate background phase variations; (2) manual creation of a fetal brain mask that includes the superior sagittal sinus (SSS); (3) inverse filtering of the resultant masked phase images using a truncated k-space approach with geometric constraint. Further, the magnetic susceptibility, ∆χ_v and corresponding putative S_vO₂ of the SSS were quantified from the generated susceptibility maps. Systematic error in the measured S_vO₂ due to the modified pipeline was also studied through simulations.

RESULTS

Simulations showed that the systematic error in S_vO₂ when using a mask that includes a minimum of 5 voxels around the SSS and five slices remains < 3% for different orientations of the vessel relative to the main magnetic field. The average ∆χ_v in the SSS quantified across all gestations was 0.42 ± 0.03 ppm. Based on ∆χ_v, the average putative S_vO₂ in the SSS across all fetuses was 67% ± 7%, which is in good agreement with published studies.

CONCLUSIONS

This in vivo study demonstrates the feasibility of using QSM in the human fetal brain to estimate ∆χ_v and S_vO₂.

KEY POINTS

• A modified quantitative susceptibility mapping (QSM) processing pipeline is tested and presented for the human fetus. • QSM is feasible in the human fetus for measuring magnetic susceptibility and oxygenation of venous blood in vivo. • Blood magnetic susceptibility values from MR susceptometry and QSM agree with each other in the human fetus.

Clinical Integration of Quantitative Susceptibility Mapping Magnetic Resonance Imaging into Neurosurgical Practice

OBJECTIVE

To introduce quantitative susceptibility mapping (QSM), a novel magnetic resonance imaging sequence, to the field of neurosurgery.

METHODS

QSM is introduced both in its historical context and by providing a brief overview of the physics behind the technique tailored to a neurosurgical audience. Its application to clinical neurosurgery is then highlighted using case examples.

RESULTS

QSM offers a quantitative assessment of susceptibility (previously considered as an artifact) via a single, straightforward gradient echo acquisition. QSM differs from standard susceptibility weighted imaging in its ability to both quantify and precisely localize susceptibility effects. Clinical applications of QSM are wide reaching and include precise localization of the deep nuclei for deep brain stimulation electrode placement, differentiation between blood products and calcification within brain lesions, and enhanced sensitivity of cerebral micrometastasis identification.

CONCLUSIONS

We present this diverse range of QSM's clinical applications to neurosurgical care via case examples. QSM can be obtained in all patients able to undergo magnetic resonance imaging and is easily integratable into busy neuroradiology programs because of its short acquisition time and straightforward, automated offline postprocessing workflow. Clinical integration of QSM may help clinicians better identify and characterize neurosurgical lesions, thereby improving patient care.

Microstructural alterations of cortical and deep gray matter over a season of high school football revealed by diffusion kurtosis imaging

OBJECTIVES

To probe microstructural changes that are associated with subconcussive head impact exposure in deep and cortical gray matter of high school football players over a single season.

METHODS

Players underwent diffusion kurtosis imaging (DKI) and quantitative susceptibility mapping (QSM) scans. Head impact data was recorded. Association between parametric changes and frequency of frontal head impact was assessed.

RESULTS

In deep gray matter, significant decreases in mean kurtosis (MK) and increases in mean diffusivity (MD) over the season were observed in the thalamus and putamen. Correlations between changes in DKI metrics and frequency of frontal impacts were observed in the putamen and caudate. In cortical gray matter, decreases in MK were observed in regions including the pars triangularis and inferior parietal. In addition, increases in MD were observed in the rostral middle frontal cortices. Negative correlations between MK and frequency of frontal impacts were observed in the posterior part of the brain including the pericalcarine, lingual and middle temporal cortices. Magnetic susceptibility values exhibited no significant difference or correlation, suggesting these diffusion changes common within the group may not be associated with iron-related mechanisms.

CONCLUSION

Microstructural alterations over the season and correlations with head impacts were captured by DKI metrics, which suggested that DKI imaging of gray matter may yield valuable biomarkers for evaluating brain injuries associated with subconcussive head impact. Findings of associations between frontal impacts and changes in posterior cortical gray matter also indicated that contrecoup injury rather than coup injury might be the dominant mechanism underlying the observed microstructural alterations.

ADVANCES IN KNOWLEDGE

Significant microstructural changes, as reflected by DKI metrics, in cortical gray matter such as the rostral middle frontal cortices, and in deep gray matter such as the thalamus were observed in high school football players over the course of a single season without clinically diagnosed concussion. QSM showed no evidence of iron-related changes in the observed subconcussive brain injuries. The detected microstructural changes in cortical and deep gray matter correlated with frequency of subconcussive head impacts.

IMPLICATIONS FOR PATIENT CARE

DKI may yield valuable biomarkers for evaluating the severity of brain injuries associated with subconcussive head impacts in contact sport athletes.

Quantitative susceptibility map analysis in preterm neonates with germinal matrix-intraventricular hemorrhage

BACKGROUND

Germinal matrix-intraventricular hemorrhage (GMH-IVH) is a common form of intracranial hemorrhage occurring in preterm neonates that may affect normal brain development. Although the primary lesion is easily identified on MRI by the presence of blood products, its exact extent may not be recognizable with conventional sequences. Quantitative susceptibility mapping (QSM) quantify the spatial distribution of magnetic susceptibility within biological tissues, including blood degradation products.

PURPOSE/HYPOTHESIS

To evaluate magnetic susceptibility of normal-appearing white (WM) and gray matter regions in preterm neonates with and without GMH-IVH.

STUDY TYPE

Retrospective case-control.

POPULATION

A total of 127 preterm neonates studied at term equivalent age: 20 had mild GMH-IVH (average gestational age 28.7 ± 2.1 weeks), 15 had severe GMH-IVH (average gestational age 29.3 ± 1.8 weeks), and 92 had normal brain MRI (average gestational age 29.8 ± 1.8 weeks).

FIELD STRENGTH/SEQUENCE

QSM at 1.5 Tesla.

ASSESSMENT

QSM analysis was performed for each brain hemisphere with a region of interest-based approach including five WM regions (centrum semiovale, frontal, parietal, temporal, and cerebellum), and a subcortical gray matter region (basal ganglia/thalami).

STATISTICAL TESTS

Changes in magnetic susceptibility were explored using a one-way analysis of covariance, according to GMH-IVH severity (P < 0.05).

RESULTS

In preterm neonates with normal brain MRI, all white and subcortical gray matter regions had negative magnetic susceptibility values (diamagnetic). Neonates with severe GMH-IVH showed higher positive magnetic susceptibility values (i.e. paramagnetic) in the centrum semiovale (0.0019 versus -0.0014 ppm; P < 0.001), temporal WM (0.0011 versus -0.0012 ppm; P = 0.037), and parietal WM (0.0005 versus -0.0001 ppm; P = 0.002) compared with controls. No differences in magnetic susceptibility were observed between neonates with mild GMH-IVH and controls (P = 0.236).

DATA CONCLUSION

Paramagnetic susceptibility changes occur in several normal-appearing WM regions of neonates with severe GMH-IVH, likely related to the accumulation of hemosiderin/ferritin iron secondary to diffusion of extracellular hemoglobin from the ventricle into the periventricular WM.

LEVEL OF EVIDENCE

4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1199-1207.

Morphology-adaptive total variation for the reconstruction of quantitative susceptibility map from the magnetic resonance imaging phase

Quantitative susceptibility mapping (QSM) is a magnetic resonance imaging technique that quantifies the magnetic susceptibility distribution within biological tissues. QSM calculates the underlying magnetic susceptibility by deconvolving the tissue magnetic field map with a unit dipole kernel. However, this deconvolution problem is ill-posed. The morphology enabled dipole inversion (MEDI) introduces total variation (TV) to regularize the susceptibility reconstruction. However, MEDI results still contain artifacts near tissue boundaries because MEDI only imposes TV constraint on voxels inside smooth regions. We introduce a Morphology-Adaptive TV (MATV) for improving TV-regularized QSM. The MATV method first classifies imaging target into smooth and nonsmooth regions by thresholding magnitude gradients. In the dipole inversion for QSM, the TV regularization weights are a monotonically decreasing function of magnitude gradients. Thus, voxels inside smooth regions are assigned with larger weights than those in nonsmooth regions. Using phantom and in vivo datasets, we compared the performance of MATV with that of MEDI. MATV results had better visual quality than MEDI results, especially near tissue boundaries. Preliminary brain imaging results illustrated that MATV has potential to improve the reconstruction of regions near tissue boundaries.

Quantitative susceptibility mapping of articular cartilage: Ex vivo findings at multiple orientations and following different degradation treatments

Purpose

We investigated the feasibility of quantitative susceptibility mapping (QSM) for assessing degradation of articular cartilage by measuring ex vivo bovine cartilage samples subjected to different degradative treatments. Specimens were scanned at several orientations to study if degradation affects the susceptibility anisotropy. T2*‐mapping, histological stainings, and polarized light microscopy were used as reference methods. Additionally, simulations of susceptibility in layered geometry were performed.

Methods

Samples (n = 9) were harvested from the patellae of skeletally mature bovines. Three specimens served as controls, and the rest were artificially degraded. MRI was performed at 9.4T using a 3D gradient echo sequence. QSM and T2* images and depth profiles through the centers of the samples were compared with each other and the histological findings. A planar isotropic model with depth‐wise susceptibility variation was used in the simulations.

Results

A strong diamagnetic contrast was seen in the deep and calcified layers of cartilage, while T2* maps reflected the typical trilaminar structure of the collagen network. Anisotropy of susceptibility in cartilage was observed and was found to differ from the T2* anisotropy. Slight changes were observed in QSM and T2* following the degradative treatments. In simulations, anisotropy was observed.

Conclusions

The results suggest that QSM is not sensitive to cartilage proteoglycan content, but shows sensitivity to the amount of calcification and to the integrity of the collagen network, providing potential for assessing osteoarthritis. The simulations suggested that the anisotropy of susceptibility might be partially explained by the layered geometry of susceptibility in cartilage.

MRI gradient-echo phase contrast of the brain at ultra-short TE with off-resonance saturation

Larmor-frequency shift or image phase measured by gradient-echo sequences has provided a new source of MRI contrast. This contrast is being used to study both the structure and function of the brain. So far, phase images of the brain have been largely obtained at long echo times as maximum phase signal-to-noise ratio (SNR) is achieved at TE = T2* (∼40 ms at 3T). The structures of the brain, however, are compartmentalized and complex with a wide range of signal relaxation times. At such long TE, the short-T2 components are largely attenuated and contribute minimally to phase contrast. The purpose of this study was to determine whether proton gradient-echo images of the brain exhibit phase contrast at ultra-short TE (UTE). Our data showed that UTE images acquired at 7 T without off-resonance saturation do not contain significant phase contrast between gray and white matter. However, UTE images of the brain can attain strong phase contrast even at a nominal TE of 106 μs by using off-resonance RF saturation pulses, which provide direct saturation of ultra-short-T2 components and indirect saturation of longer-T2 components via magnetization transfer. In addition, phase contrast between gray and white matter acquired at UTE with off-resonance saturation is reversed compared to that of the long-T2 signals acquired at long TEs. This finding opens up a potential new way to manipulate image phase contrast of the brain. By accessing short and ultra-short-T2 species, MRI phase images may further improve the characterization of tissue microstructure in the brain.

Quantitative Susceptibility Mapping (QSM) Algorithms: Mathematical Rationale and Computational Implementations

Quantitative susceptibility mapping (QSM) solves the magnetic field-to-magnetization (tissue susceptibility) inverse problem under conditions of noisy and incomplete field data acquired using magnetic resonance imaging. Therefore, sophisticated algorithms are necessary to treat the ill-posed nature of the problem and are reviewed here. The forward problem is typically presented as an integral form, where the field is the convolution of the dipole kernel and tissue susceptibility distribution. This integral form can be equivalently written as a partial differential equation (PDE). Algorithmic challenges are to reduce streaking and shadow artifacts characterized by the fundamental solution of the PDE. Bayesian maximum a posteriori estimation can be employed to solve the inverse problem, where morphological and relevant biomedical knowledge (specific to the imaging situation) are used as priors. As the cost functions in Bayesian QSM framework are typically convex, solutions can be robustly computed using a gradient-based optimization algorithm. Moreover, one can not only accelerate Bayesian QSM, but also increase its effectiveness at reducing shadows using prior knowledge based preconditioners. Improving the efficiency of QSM is under active development, and a rigorous analysis of preconditioning needs to be carried out for further investigation.Quantitative susceptibility mapping (QSM) solves the magnetic field-to-magnetization (tissue susceptibility) inverse problem under conditions of noisy and incomplete field data acquired using magnetic resonance imaging. Therefore, sophisticated algorithms are necessary to treat the ill-posed nature of the problem and are reviewed here. The forward problem is typically presented as an integral form, where the field is the convolution of the dipole kernel and tissue susceptibility distribution. This integral form can be equivalently written as a partial differential equation (PDE). Algorithmic challenges are to reduce streaking and shadow artifacts characterized by the fundamental solution of the PDE. Bayesian maximum a posteriori estimation can be employed to solve the inverse problem, where morphological and relevant biomedical knowledge (specific to the imaging situation) are used as priors. As the cost functions in Bayesian QSM framework are typically convex, solutions can be robustly computed using a gradient-based optimization algorithm. Moreover, one can not only accelerate Bayesian QSM, but also increase its effectiveness at reducing shadows using prior knowledge based preconditioners. Improving the efficiency of QSM is under active development, and a rigorous analysis of preconditioning needs to be carried out for further investigation.

Quantitative susceptibility mapping: Report from the 2016 reconstruction challenge

PURPOSE

The aim of the 2016 quantitative susceptibility mapping (QSM) reconstruction challenge was to test the ability of various QSM algorithms to recover the underlying susceptibility from phase data faithfully.

METHODS

Gradient-echo images of a healthy volunteer acquired at 3T in a single orientation with 1.06 mm isotropic resolution. A reference susceptibility map was provided, which was computed using the susceptibility tensor imaging algorithm on data acquired at 12 head orientations. Susceptibility maps calculated from the single orientation data were compared against the reference susceptibility map. Deviations were quantified using the following metrics: root mean squared error (RMSE), structure similarity index (SSIM), high-frequency error norm (HFEN), and the error in selected white and gray matter regions.

RESULTS

Twenty-seven submissions were evaluated. Most of the best scoring approaches estimated the spatial frequency content in the ill-conditioned domain of the dipole kernel using compressed sensing strategies. The top 10 maps in each category had similar error metrics but substantially different visual appearance.

CONCLUSION

Because QSM algorithms were optimized to minimize error metrics, the resulting susceptibility maps suffered from over-smoothing and conspicuity loss in fine features such as vessels. As such, the challenge highlighted the need for better numerical image quality criteria. Magn Reson Med 79:1661-1673, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Quantitative susceptibility mapping in combination with water-fat separation for simultaneous liver iron and fat fraction quantification

PURPOSES

To evaluate the feasibility of simultaneous quantification of liver iron concentration (LIC) and fat fraction (FF) using water-fat separation and quantitative susceptibility mapping (QSM).

METHODS

Forty-five patients suspected of liver iron overload (LIO) were included. A volumetric interpolated breath-hold examination sequence for QSM and FF, a fat-saturated gradient echo sequence for R₂^*, a spin echo sequence for LIC measurements and MRS analyses for FF (FF-MRS) were performed. Magnetic susceptibility and FF were calculated using a water-fat separation method (FF-MRI). Correlation and receiver operating characteristic analyses were performed.

RESULTS

Magnetic susceptibility showed strong correlation with LIC (r_s=0.918). The optimal susceptibility cut-off values were 0.34, 0.63, 1.29 and 2.23 ppm corresponding to LIC thresholds of 1.8, 3.2, 7.0 and 15.0 mg/g dry weight. The area under the curve (AUC) were 0.948, 0.970, 1 and 1, respectively. No difference in AUC was found between susceptibility and R₂^* at all LIC thresholds. Correlation was found between FF-MRI and FF-MRS (R²=0.910).

CONCLUSIONS

QSM has a high diagnostic performance for LIC quantification, similar to that of R₂^*. FF-MRI provides simultaneous fat quantification. Findings suggest QSM in combination with water-fat separation has potential value for evaluating LIO, especially in cases with coexisting steatosis.

KEY POINTS

• Magnetic susceptibility showed strong correlation with LIC (r _s =0.918). • QSM showed high diagnostic performance for LIC, similar to that of R ₂^* . • Simultaneously estimated FF-MRI showed strong correlation with MR-Spectroscopy-based FF (R ² =0.910). • QSM combining water-fat separation has quantitative value for LIO with coexisted steatosis.

Nuclei-specific deposits of iron and calcium in the rat thalamus after status epilepticus revealed with quantitative susceptibility mapping (QSM)

PURPOSE

To investigate pathological changes in the rat brain after pilocarpine-induced status epilepticus using quantitative susceptibility mapping (QSM).

MATERIALS AND METHODS

3D multiecho gradient-echo (GRE) data were acquired from ex vivo brains of pilocarpine-injected and age-matched control rats at 11.7T. Maps of R2* and quantitative susceptibility were calculated from the acquired 3D GRE magnitude and phase data, respectively. QSM and R2* maps were compared with Perls' (iron) and Alizarin-red-S (calcium) stainings in the same brains to investigate the pathophysiological basis of susceptibility contrast.

RESULTS

Bilaterally symmetric lesions were detected in reproducible thalamic regions of pilocarpine-treated rats, characterized by hyperintensity in R2* maps. In comparison, quantitative susceptibility maps demonstrated heterogeneous contrast within the lesions, with distinct hyperintense (paramagnetic) and hypointense (diamagnetic) areas. Comparison with histological assessment revealed localized deposits of iron- and calcium-positive granules in thalamic nuclei corresponding to paramagnetic and diamagnetic areas delineated in the susceptibility maps, respectively. Pronounced differences were observed in the lesions between background-corrected phase images and reconstructed susceptibility maps, indicating unreliable differentiation of iron and calcium deposits in phase maps. Multiple linear regression showed a significant association between susceptibility values and measured optical densities (ODs) of iron and calcium in the lesions (R2  = 0.42, P < 0.001), with a positive dependence on OD of iron and negative dependence on OD of calcium.

CONCLUSION

QSM can detect and differentiate pathological iron and calcium deposits with high sensitivity and improved spatial accuracy compared to R2* or GRE phase images, rendering it a promising technique for diagnosing thalamic lesions after status epilepticus.

LEVEL OF EVIDENCE

1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:554-564.

Susceptibility Weighted MRI in Rodents at 9.4 T

Susceptibility Weighted Imaging (SWI) is an established part of the clinical neuroimaging toolbox and, since its inception, has also successfully been used in various preclinical studies. Exploiting the effect of variations of magnetic susceptibility between different tissues on the externally applied, static, homogeneous magnetic field, the method visualizes venous vasculature, hemorrhages and blood degradation products, calcifications, and tissue iron deposits. The chapter describes in vivo and ex vivo protocols for preclinical SWI in rodents.

RESUME: Turning an SWI acquisition into a fast qMRI protocol

Susceptibility Weighted Imaging (SWI) is a common MRI technique that exploits the magnetic susceptibility differences between the tissues to provide valuable image contrasts, both in research and clinical contexts. However, despite its increased clinical use, SWI is not intrinsically suitable for quantitation purposes. Conversely, quantitative Magnetic Resonance Imaging (qMRI) provides a way to disentangle the sources of common MR image contrasts (e.g. proton density, T₁, etc.) and to measure physical parameters intrinsically related to tissue microstructure. Unfortunately, the poor signal-to-noise ratio and resolution, coupled with the long imaging time of most qMRI strategies, have hindered the integration of quantitative imaging into clinical protocols. Here we present the RElaxometry and SUsceptibility Mapping Expedient (RESUME) to show that the standard acquisition leading to a clinical SWI dataset can be easily turned into a thorough qMRI protocol at the cost of a further 50% of the SWI scan time. The R₁, R2*, proton density and magnetic susceptibility maps provided by the RESUME scheme alongside the SWI reconstruction exhibit high reproducibility and accuracy, and a submillimeter resolution is proven to be compatible with a total scan time of 7 minutes.

Ex-vivo quantitative susceptibility mapping of human brain hemispheres

Ex-vivo brain quantitative susceptibility mapping (QSM) allows investigation of brain characteristics at essentially the same point in time as histopathologic examination, and therefore has the potential to become an important tool for determining the role of QSM as a diagnostic and monitoring tool of age-related neuropathologies. In order to be able to translate the ex-vivo QSM findings to in-vivo, it is crucial to understand the effects of death and chemical fixation on brain magnetic susceptibility measurements collected ex-vivo. Thus, the objective of this work was twofold: a) to assess the behavior of magnetic susceptibility in both gray and white matter of human brain hemispheres as a function of time postmortem, and b) to establish the relationship between in-vivo and ex-vivo gray matter susceptibility measurements on the same hemispheres. Five brain hemispheres from community-dwelling older adults were imaged ex-vivo with QSM on a weekly basis for six weeks postmortem, and the longitudinal behavior of ex-vivo magnetic susceptibility in both gray and white matter was assessed. The relationship between in-vivo and ex-vivo gray matter susceptibility measurements was investigated using QSM data from eleven older adults imaged both antemortem and postmortem. No systematic change in ex-vivo magnetic susceptibility of gray or white matter was observed over time postmortem. Additionally, it was demonstrated that, gray matter magnetic susceptibility measured ex-vivo may be well modeled as a linear function of susceptibility measured in-vivo. In conclusion, magnetic susceptibility in gray and white matter measured ex-vivo with QSM does not systematically change in the first six weeks after death. This information is important for future cross-sectional ex-vivo QSM studies of hemispheres imaged at different postmortem intervals. Furthermore, the linear relationship between in-vivo and ex-vivo gray matter magnetic susceptibility suggests that ex-vivo QSM captures information linked to antemortem gray matter magnetic susceptibility, which is important for translation of ex-vivo QSM findings to in-vivo.

Susceptibility tensor imaging and tractography of collagen fibrils in the articular cartilage

PURPOSE

To investigate the B0 orientation-dependent magnetic susceptibility of collagen fibrils within the articular cartilage and to determine whether susceptibility tensor imaging (STI) can detect the 3D collagen network within cartilage.

METHODS

Multiecho gradient echo datasets (100-μm isotropic resolution) were acquired from fixed porcine articular cartilage specimens at 9.4 T. The susceptibility tensor was calculated using phase images acquired at 12 or 15 different orientations relative to B0 . The susceptibility anisotropy of the collagen fibril was quantified and diffusion tensor imaging (DTI) was compared against STI. 3D tractography was performed to visualize and track the collagen fibrils with DTI and STI.

RESULTS

STI experiments showed the distinct and significant anisotropic magnetic susceptibility of collagen fibrils within the articular cartilage. STI can be used to measure and quantify susceptibility anisotropy maps. Furthermore, STI provides orientation information of the underlying collagen network via 3D tractography.

CONCLUSION

The findings of this study demonstrate that STI can characterize the orientation variation of collagen fibrils where diffusion anisotropy fails. We believe that STI could serve as a sensitive and noninvasive marker to study the collagen fibrils microstructure. Magn Reson Med 78:1683-1690, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Overview of quantitative susceptibility mapping

Magnetic susceptibility describes the magnetizability of a material to an applied magnetic field and represents an important parameter in the field of MRI. With the recently introduced method of quantitative susceptibility mapping (QSM) and its conceptual extension to susceptibility tensor imaging (STI), the non-invasive assessment of this important physical quantity has become possible with MRI. Both methods solve the ill-posed inverse problem to determine the magnetic susceptibility from local magnetic fields. Whilst QSM allows the extraction of the spatial distribution of the bulk magnetic susceptibility from a single measurement, STI enables the quantification of magnetic susceptibility anisotropy, but requires multiple measurements with different orientations of the object relative to the main static magnetic field. In this review, we briefly recapitulate the fundamental theoretical foundation of QSM and STI, as well as computational strategies for the characterization of magnetic susceptibility with MRI phase data. In the second part, we provide an overview of current methodological and clinical applications of QSM with a focus on brain imaging. Copyright © 2016 John Wiley & Sons, Ltd.

An illustrated comparison of processing methods for phase MRI and QSM: removal of background field contributions from sources outside the region of interest

The elimination of so-called background fields is an essential step in phase MRI and quantitative susceptibility mapping (QSM). Background fields, which are caused by sources outside the region of interest (ROI), are often one to two orders of magnitude stronger than tissue-related field variations from within the ROI, hampering quantitative interpretation of field maps. This paper reviews the current literature on background elimination algorithms for QSM and provides insights into similarities and differences between the many algorithms proposed. We discuss the basic theoretical foundations and derive fundamental limitations of background field elimination. Copyright © 2016 John Wiley & Sons, Ltd.

Characterizing Brain Iron Deposition in Patients with Subcortical Vascular Mild Cognitive Impairment Using Quantitative Susceptibility Mapping: A Potential Biomarker

The presence and pattern of iron accumulation in subcortical vascular mild cognitive impairment (svMCI) and their effects on cognition have rarely been investigated. We aimed to examine brain iron deposition in svMCI subjects using quantitative susceptibility mapping (QSM). Moreover, we aimed to investigate the correlation between brain iron deposition and the severity of cognitive impairment as indicated by z-scores. We recruited 20 subcortical ischemic vascular disease (SIVD) patients who fulfilled the criteria for svMCI. The control group comprised 19 SIVD patients without cognitive impairment. The SIVD and control groups were matched based on age, gender, and years of education. Both groups underwent QSM using a 3.0T MRI system. Susceptibility maps were reconstructed from in vivo data, which were acquired with a three-dimensional spoiled gradient recalled sequence. Then, regions of interest were drawn manually on the map of each subject. The inter-group differences of susceptibility values were explored in deep gray matter nuclei, including the bilateral pulvinar nucleus of the thalamus, head of caudate nucleus, globus pallidus, putamen, hippocampus, substantia nigra, and red nucleus. The correlations between regional iron deposition and composite z-score, memory z-score, language z-score, attention-executive z-score and visuospatial z-score were assessed using partial correlation analysis, with patient age and gender as covariates. Compared with the control, the svMCI group had elevated susceptibility values within the bilateral hippocampus and right putamen. Furthermore, the susceptibility value in the right hippocampus was negatively correlated with memory z-score and positively correlated with language z-score. The susceptibility value in the right putamen was negatively correlated with attention-executive z-score in the svMCI group. However, composite z-score were unrelated to susceptibility values. Our results suggest that brain iron deposition has clinical relevance as a biomarker for cognition. In addition, our results highlight the importance of iron deposition in understanding svMCI-associated cognitive deficits in addition to conventional MRI markers.

Methods for the computation of templates from quantitative magnetic susceptibility maps (QSM): Toward improved atlas- and voxel-based analyses (VBA)

PURPOSE

To develop and assess a method for the creation of templates for voxel-based analysis (VBA) and atlas-based approaches using quantitative magnetic susceptibility mapping (QSM).

MATERIALS AND METHODS

We studied four strategies for the creation of magnetic susceptibility brain templates, derived as successive extensions of the conventional template generation (CONV) based on only T₁ -weighted (T₁ w) images. One method that used only T₁ w images involved a minor improvement of CONV (U-CONV). One method used only magnetic susceptibility maps as input for template generation (DIRECT), and the other two used a linear combination of susceptibility and T₁ w images (HYBRID) and an algorithm that directly used both image modalities (MULTI), respectively. The strategies were evaluated in a group of N = 10 healthy human subjects and semiquantitatively assessed by three experienced raters. Template quality was compared statistically via worth estimates (WEs) obtained with a log-linear Bradley-Terry model.

RESULTS

The overall quality of the templates was better for strategies including both susceptibility and T₁ w contrast (MULTI: WE = 0.62; HYBRID: WE = 0.21), but the best method depended on the anatomical region of interest. While methods using only one modality resulted in lower WEs, lowest overall WEs were obtained when only T₁ w images were used (DIRECT: WE = 0.12; U-CONV: WE = 0.05).

CONCLUSION

Template generation strategies that employ only magnetic susceptibility contrast or both magnetic susceptibility and T₁ w contrast produce templates with the highest quality. The optimal approach depends on the anatomical structures of interest. The established approach of using only T₁ w images (CONV) results in reduced image quality compared to all other approaches studied.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1474-1484.

Susceptibility-Based Neuroimaging: Standard Methods, Clinical Applications, and Future Directions

The evaluation of neuropathologies using MRI methods that leverage tissue susceptibility have become standard practice, especially to detect blood products or mineralization. Additionally, emerging MRI techniques have the ability to provide new information based on tissue susceptibility properties in a robust and quantitative manner. This paper discusses these advanced susceptibility imaging techniques and their clinical applications.

Exploring the origins of echo-time-dependent quantitative susceptibility mapping (QSM) measurements in healthy tissue and cerebral microbleeds

Quantitative susceptibility mapping (QSM) is increasingly used to measure variation in tissue composition both in the brain and in other areas of the body in a range of disease pathologies. Although QSM measurements were originally believed to be independent of the echo time (TE) used in the gradient-recalled echo (GRE) acquisition from which they are derived; recent literature (Sood et al., 2016) has shown that these measurements can be highly TE-dependent in a number of brain regions. In this work we systematically investigate possible causes of this effect through analysis of apparent frequency and QSM measurements derived from data acquired at multiple TEs in vivo in healthy brain regions and in cerebral microbleeds (CMBs); QSM data acquired in a gadolinium-doped phantom; and in QSM data derived from idealized simulated phase data. Apparent frequency measurements in the optic radiations (OR) and central corpus callosum (CC) were compared to those predicted by a 3-pool white matter model, however the model failed to fully explain contrasting frequency profiles measured in the OR and CC. Our results show that TE-dependent QSM measurements can be caused by a failure of phase unwrapping algorithms in and around strong susceptibility sources such as CMBs; however, in healthy brain regions this behavior appears to result from intrinsic non-linear phase evolution in the MR signal. From these results we conclude that care must be taken when deriving frequency and QSM measurements in strong susceptibility sources due to the inherent limitations in phase unwrapping; and that while signal compartmentalization due to tissue microstructure and content is a plausible cause of TE-dependent frequency and QSM measurements in healthy brain regions, better sampling of the MR signal and more complex models of tissue are needed to fully exploit this relationship.

Investigating magnetic susceptibility of human knee joint at 7 Tesla

PURPOSE

To evaluate the magnetic susceptibility properties of different anatomical structures within the knee joint using quantitative susceptibility mapping (QSM).

METHODS

A collagen tissue model was simulated and ex vivo animal cartilage experiments were conducted at 9.4 Tesla (T) to evaluate the B₀ orientation-dependent magnetic susceptibility contrast observed in cartilage. Furthermore, nine volunteers (six healthy subjects without knee pain history and three patients with known knee injury, between 29 and 58 years old) were scanned using gradient-echo acquisitions on a high-field 7T MR scanner. Susceptibility values of different tissues were quantified and diseased cartilage and meniscus were compared against that of healthy volunteers.

RESULTS

Simulation and ex vivo animal cartilage experiments demonstrated that collagen fibrils exhibit an anisotropic susceptibility. A gradual change of magnetic susceptibility was observed in the articular cartilage from the superficial zone to the deep zone, forming a multilayer ultrastructure consistent with anisotropy of collagen fibrils. Meniscal tears caused a clear reduction of susceptibility contrast between the injured meniscus and surrounding cartilage illustrated by a loss of the sharp boundaries between the two. Moreover, QSM showed more dramatic contrast in the focal degenerated articular cartilage than R2* mapping.

CONCLUSION

The arrangement of the collagen fibrils is significant, and likely the most dominant source of magnetic susceptibility anisotropy. Quantitative susceptibility mapping offers a means to characterize magnetic susceptibility properties of tissues in the knee joint. It is sensitive to collagen damage or degeneration and may be useful for evaluating the status of knee diseases, such as meniscal tears and cartilage disease. Magn Reson Med 78:1933-1943, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Structure Prior Effects in Bayesian Approaches of Quantitative Susceptibility Mapping

Quantitative susceptibility mapping (QSM) has shown its potential for anatomical and functional MRI, as it can quantify, for in vivo tissues, magnetic biomarkers and contrast agents which have differential susceptibilities to the surroundings substances. For reconstructing the QSM with a single orientation, various methods have been proposed to identify a unique solution for the susceptibility map. Bayesian QSM approach is the major type which uses various regularization terms, such as a piece-wise constant, a smooth, a sparse, or a morphological prior. Six QSM algorithms with or without structure prior are systematically discussed to address the structure prior effects. The methods are evaluated using simulations, phantom experiments with the given susceptibility, and human brain data. The accuracy and image quality of QSM were increased when using structure prior in the simulation and phantom compared to same regularization term without it, respectively. The image quality of QSM method using the structure prior is better comparing, respectively, to the method without it by either sharpening the image or reducing streaking artifacts in vivo. The structure priors improve the performance of the various QSMs using regularized minimization including L1, L2, and TV norm.

Imaging whole-brain cytoarchitecture of mouse with MRI-based quantitative susceptibility mapping

The proper microstructural arrangement of complex neural structures is essential for establishing the functional circuitry of the brain. We present an MRI method to resolve tissue microstructure and infer brain cytoarchitecture by mapping the magnetic susceptibility in the brain at high resolution. This is possible because of the heterogeneous magnetic susceptibility created by varying concentrations of lipids, proteins and irons from the cell membrane to cytoplasm. We demonstrate magnetic susceptibility maps at a nominal resolution of 10-μm isotropic, approaching the average cell size of a mouse brain. The maps reveal many detailed structures including the retina cell layers, olfactory sensory neurons, barrel cortex, cortical layers, axonal fibers in white and gray matter. Olfactory glomerulus density is calculated and structural connectivity is traced in the optic nerve, striatal neurons, and brainstem nerves. The method is robust and can be readily applied on MRI scanners at or above 7T.

MRI-based quantitative susceptibility mapping (QSM) and R2* mapping of liver iron overload: Comparison with SQUID-based biomagnetic liver susceptometry

PURPOSE

We aimed to determine the agreement between quantitative susceptibility mapping (QSM)-based biomagnetic liver susceptometry (BLS) and confounder-corrected R2* mapping with superconducting quantum interference device (SQUID)-based biomagnetic liver susceptometry in patients with liver iron overload.

METHODS

Data were acquired from two healthy controls and 22 patients undergoing MRI and SQUID-BLS as part of routine monitoring for iron overload. Magnetic resonance imaging was performed on a 3T system using a three-dimensional multi-echo gradient-echo acquisition. Both magnetic susceptibility and R2* of the liver were estimated from this acquisition. Linear regression was used to compare estimates of QSM-BLS and R2* to SQUID-BLS.

RESULTS

Both QSM-BLS and confounder-corrected R2* were sensitive to the presence of iron in the liver. Linear regression between QSM-BLS and SQUID-BLS demonstrated the following relationship: QSM-BLS = (-0.22 ± 0.11) + (0.49 ± 0.05) · SQUID-BLS with r²  = 0.88. The coefficient of determination between liver R2* and SQUID-BLS was also r²  = 0.88.

CONCLUSION

We determined a strong correlation between both QSM-BLS and confounder-corrected R2* to SQUID-BLS. This study demonstrates the feasibility of QSM-BLS and confounder-corrected R2* for assessing liver iron overload, particularly when SQUID systems are not accessible. Magn Reson Med 78:264-270, 2017. © 2016 International Society for Magnetic Resonance in Medicine.